妊娠期糖尿病患者血清microRNA-17、Netrin4的表达及与妊娠结局的关系

Expressions of serum microRNA-17 and netrin-4 in patients with gestational diabetes mellitus and their relationship with pregnancy outcomes

摘要:

目的 探讨妊娠期糖尿病（GDM）患者血清microRNA-17（miR-17）、Netrin4的表达及与妊娠结局的关系。方法 回顾性分析2022年1月—2023年6月南通大学第二附属医院收治的GDM患者98例。根据妊娠结局将患者分为对照组（正常妊娠结局）和研究组（不良妊娠结局），分别为65和33例。收集患者临床资料包括受试者年龄、孕产次、口服葡萄糖耐量试验（OGTT）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、甘油三酯（TG）、白蛋白（ALB）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）。采用实时荧光定量聚合酶链反应检测miR-17和Netrin4的表达。分析影响GDM患者发生不良妊娠结局的因素。结果 对照组与研究组体质量指数（BMI）、OGTT 2 h、HbA1c、HOMA-IR比较，差异均有统计学意义（P <0.05）。研究组miR-17相对表达量高于对照组（P <0.05），Netrin4相对表达量低于对照组（P <0.05）。多因素一般Logistic回归分析结果显示：高水平OGTT 2h ［O^R=1.548（95% CI：1.512，2.531）］、高水平HbA1c ［O^R=3.041（95% CI：1.054，3.412）］、高表达miR-17 ［O^R=2.865（95% CI：0.741，3.905）］及低表达Netrin4 ［O^R=0.743（95%CI：0.378，0.835）］均是不良妊娠结局的危险因素（P <0.05）。结论 GDM患者血清miR-17表达升高和Netrin4表达降低是发生不良妊娠结局的影响因素。

Abstract:

Objective To investigate the expressions of serum microRNA-17 (miR-17) and netrin-4 in patients with gestational diabetes mellitus (GDM) and their relationship with pregnancy outcomes.Methods A retrospective analysis was conducted on 98 GDM patients diagnosed and treated in the Second Affiliated Hospital of Nantong University from January 2022 to June 2023. According to the pregnancy outcomes, GDM patients were divided into the control group (normal pregnancy outcomes) and the study group (adverse pregnancy outcomes), with 65 and 33 cases, respectively. Clinical data of all patients were collected, including age, gravidity and parity, results of the oral glucose tolerance test (OGTT), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), albumin (ALB), fasting insulin (FINS), and insulin resistance index (HOMA-IR). The expressions of miR-17 and netrin-4 were measured by quantitative real-time polymerase chain reaction. The factors contributing to unfavorable pregnancy outcomes in GDM were analyzed.Results There were significant differences in BMI, results of OGTT at 2 h, the level of HbA1c, and HOMA-IR between the control group and the study group (P < 0.05). Compared with the control group, the relative expression of miR-17 in the study group was higher (P <0.05), while the relative expression of netrin-4 was lower in the study group (P < 0.05). Multivariable Logistic regression analysis (inclusion of variables with P-value < 0.05 and exclusion of variables with P-value > 0.10) showed that high 2-hour plasma glucose levels in OGTT [O^R = 1.548 (95% CI: 1.512, 2.531) ], high HbA1c levels [O^R = 3.041 (95% CI: 1.054, 3.412) ], high expressions of miR-17 [O^R = 2.865 (95% CI: 0.741, 3.905) ], and low expressions of netrin-4 [O^R = 0.743 (95% CI: 0.378, 0.835) ] were all risk factors for adverse pregnancy outcomes (P < 0.05).Conclusions The increased expression of miR-17 and the decreased expression of netrin-4 in the serum of GDM patients are both factors contributing to the adverse pregnancy outcomes.